Anaesthetic Adverse Events During Propofol-Based Sedation for ERCP: A Real-World Cohort Study

Area of Science:

• Anesthesiology
• Gastroenterology
• Patient Safety

Background:

• Deep sedation for ERCP is often propofol-based, administered by anesthesiologists.
• Real-world data on adverse events (AEs) and their predictors in this setting are limited.

Purpose of the Study:

• To assess the frequency, predictors, and clinical significance of AEs during anesthesiologist-delivered propofol sedation for ERCP.
• To identify modifiable risk factors for AEs to improve patient safety.

Main Methods:

• Retrospective cohort study of 388 adult patients undergoing ERCP with propofol sedation.
• AEs classified into three tiers: physiological events, clinically significant events requiring intervention, and high-severity outcomes.
• Multivariable logistic regression used to identify predictors of Tier 2 events.

Main Results:

• 56.7% of patients experienced physiological AEs, mostly minor.
• 27.8% had clinically significant AEs requiring intervention, primarily hypotension.
• Propofol dose (OR 1.20), ASA status (OR 1.63), age (OR 1.04), and ketamine use (OR 2.18) predicted significant AEs.

Conclusions:

• While AEs are frequent, they are typically minor. Propofol dose is a key modifiable risk factor.
• Age and ASA physical status identify high-risk patients for significant AEs.
• Anesthesiologist-led propofol sedation for ERCP is safe when titrated carefully, avoiding anticipatory dosing in high-risk individuals.